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Valdez C, Rodrigues R, Reid J, Anderson KK. Disparities in Access to a Regular Primary Care Physician Among First-Generation Migrants with Early Psychosis in Ontario, Canada. Community Ment Health J 2024; 60:1237-1241. [PMID: 38592350 DOI: 10.1007/s10597-024-01266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
Disparities in primary care utilization among migrants with early psychosis may be related to lack of access to a regular primary care physician. This study aimed to investigate access to a regular primary care physician among first-generation migrants with early psychosis. People aged 14-35 years with first onset non-affective psychotic disorder in Ontario, Canada were identified in health administrative data (N = 39,440). Access to a regular primary care physician through enrollment in the year prior to diagnosis was compared between first-generation migrants (categorized by country of birth) and the general population using modified Poisson regression. Most migrant groups had a lower prevalence of regular primary care physician access relative to the general population, particularly migrants from Africa (African migrants: 81% vs. non-migrants: 89%). Adjustment for sociodemographic and clinical factors attenuated these differences, although the disparities for migrants from Africa remained (PR = 0.96, 95%CI = 0.94-0.99). Interventions aimed at improving primary care physician access in migrant groups may facilitate help-seeking and improve pathways to care in early psychosis.
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Affiliation(s)
- Crystal Valdez
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada
| | | | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada.
- ICES Western, London, ON, Canada.
- Department of Psychiatry, Schulich School of Medicine & Dentistry, London, ON, Canada.
- Department of Epidemiology and Biostatistics, The Western Centre for Public Health and Family Medicine, Western University, 1465 Richmond Street, N6G 2M1, London, ON, Canada.
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Schraeder K, Nettel-Aguirre A, Mackie AS, McBrien K, Barrett O, Dimitropoulos G, Samuel S. Primary care service use during adolescence and young adulthood: Tertiary care cohort affected by chronic health conditions. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e151-e160. [PMID: 35552227 PMCID: PMC9097743 DOI: 10.46747/cfp.6805e151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand use of family physician services and emergency department visits by adolescents and young adults with chronic health conditions. DESIGN Longitudinal retrospective observational cohort study using administrative health data. SETTING Chronic care clinics at a tertiary care pediatric hospital in Calgary, Alta. PARTICIPANTS In total, 1326 adolescents who were between 12 and 15 years old in 2008, who were observed until 2016, and who received medical services for chronic conditions were enrolled in the study. Eligible participants had at least 4 visits to the same chronic disease clinic in any 2-year window before age 18. MAIN OUTCOMES MEASURES Group-based trajectory modeling was used to identify groups of adolescents with distinct patterns of health care use (for visits to emergency departments and to primary care practices), while 2 tests explored trajectory group differences (eg, sex, location of residence). RESULTS Median age was 14 years (range 12 to 17 years) at study entry, and 22 years (range 14 to 24 years) at study exit. Half were female and most (85.4%) lived in an urban area. Median observation period was 8.7 person-years (range 1.3 to 9.1 years). Group-based trajectory modeling identified 5 distinct trajectory groups of primary care use and 4 groups of emergency services use. Groups differed by sex and location of residence in each trajectory model. CONCLUSION Many adolescents increased their use of emergency services between the ages of 12 and 24 years, with distinct patterns of primary care use being observed. Association of additional patient- and system-level factors (eg, disease severity, distance to nearest family physician office) should be explored.
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Affiliation(s)
- Kyleigh Schraeder
- Registered clinical psychologist in Alberta; at the time this manuscript was submitted, Dr Schraeder was a postdoctoral scholar in the Department of Pediatrics at the University of Calgary.
| | - Alberto Nettel-Aguirre
- Statistician in the Cumming School of Medicine at the University of Calgary at the time this manuscript was submitted
| | - Andrew S Mackie
- Associate Professor in the Department of Pediatrics at the University of Alberta in Edmonton
| | - Kerry McBrien
- Associate Professor in Community Health Sciences at the University of Calgary
| | - Olesya Barrett
- Senior Analyst in Clinical Analytics at Alberta Health Services in Calgary
| | - Gina Dimitropoulos
- Associate Professor in the Faculty of Social Work at the University of Calgary
| | - Susan Samuel
- Associate Professor in the Departments of Pediatrics and Community Health Sciences at the University of Calgary
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Gong Y, Yan J, Deng Y, Bao C, Yi Q, Liu J, Zhang Z. Examining impulsivity and risky decision making among school youth in balloon analogue risk task. Transl Pediatr 2022; 11:127-137. [PMID: 35242659 PMCID: PMC8825929 DOI: 10.21037/tp-21-594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Impulsivity trait as a risk factor which typically displayed in risk decision among school youth. This study aims to examine behavioral and cognitive problems of risky decision among Chinese young people aged 15-25 years. The balloon analogue risk task (BART) and event-related potential (ERP) were combine used to explore the neural mechanism of risky decision process whether infected by impulsivity trait. METHODS A total of 31 subjects were included, including 16 experimental subjects with risk behavior (RS), and 15 health control subjects with non-risk behavior (HC). BART were used to measure risk-taking propensity and ERP were to record in real time. RS vs. HC were compared to explain the relationship between impulsivity and risky decision. RESULTS Behavioral data in BART task shown that the RS subjects tended to make risky decisions. ERP results illustrate that P300 in RS subjects is more significant positive-going than HC that means dysfunction of cognitive control, and FRN in RS subjects is more negative-going than HC in negative feedback condition, which means individual with high impulsive would be more sensitive to unexpected outcome. CONCLUSIONS Impulsiveness is a risk factor for school adolescent, because RS subjects performed more risky decision than control group, the evidence indicate that individual with high impulsiveness would lead to be less sensitive to harmful consequences and more inclination to immediate rewards. Therefore, the inclination of risk taking can be powerfully informed by different levels of impulsiveness.
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Affiliation(s)
- Ying Gong
- Department of Nursing, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Jin Yan
- Department of Nursing, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Yunlong Deng
- Department of Clinical Psychology, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Cuiyu Bao
- Office of Academic Affairs, Hubei University of Science and Technology, Xianning, China
| | - Qifeng Yi
- Department of Nursing, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Liu
- Department of Nursing, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhihao Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
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Holtz C, Gilliland J, Thind A, Wilk P, Campbell MK. Inequitable health service use in a Canadian paediatric population: A cross-sectional study of individual- and contextual-level factors. Child Care Health Dev 2018; 44:188-194. [PMID: 28736871 DOI: 10.1111/cch.12489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health service use may be influenced by multilevel predisposing, enabling, and need factors but is equitable when driven by need. The study's objectives were as follows: (a) to investigate residential context's effect on child health service use and (b) to examine inequity of child health service use by testing for effect measure modification of need factors. METHODS The sample of 1,451 children was from a prenatal cohort recruited from London, Ontario, between 2002 and 2004, with follow-up until children were toddler/preschooler-aged. Individual-level data were linked by residential address to neighbourhood contextual-level data sourced from Statistics Canada. Multilevel logistic regression modelled factors associated with child health service use. Interaction terms were included in the model to test for effect measure modification of need factors by predisposing and enabling factors. RESULTS Contextual-level factors were not associated with child health service use. Maternal parity and nativity to Canada modified the effect of the need factor, paediatric health condition, on health service use. Health condition's effect was lowest in children of Canadian-born mothers with one child only (OR = 1.58, p = .04) and highest in children of Canadian-born mothers with three or more children (OR = 3.52, p < .01). Further, its effect was higher in children of Canadian-born mothers compared to children of mothers who migrated to Canada; however, odds ratios were not statistically significant for the latter. CONCLUSIONS Results may inform future investigation of the potential inequity of health service use for subgroups of children whose mothers are of lower parity and not Canadian-born. An understanding of these inequities may inform future healthcare policy and care for paediatric populations.
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Affiliation(s)
- C Holtz
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - J Gilliland
- Children's Health Research Institute, London, ON, Canada.,Department of Geography, Western University, London, ON, Canada
| | - A Thind
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - P Wilk
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - M K Campbell
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
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Ascione F, Cascone D, Napolitano F, Di Giuseppe G. Evaluation of the use of health care services for non-communicable disease and prevention by children and adolescents in south Italy. BMC Health Serv Res 2017; 17:532. [PMID: 28778162 PMCID: PMC5545043 DOI: 10.1186/s12913-017-2489-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 08/01/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The objectives of this investigation are to evaluate the use of health care services for non-communicable disease and prevention by children and adolescents and to identify the factors linked to the use of health care services. METHODS This cross-sectional survey was conducted between December 2014 and January 2015 among 1198 parents of students aged between 5 and 18 years attending 12 selected schools in the geographic area of Salerno and Naples, Italy, using a self-administered questionnarie. RESULTS 68.2% of parents stated that had visited their general practitioner (GP) or family pediatrician (FP) with their child in the last year. 66.2% of children had had at least one visit to a specialist and more than half (54.8%) had had preventive care visits in the last year. The use of preventive care visits within last year was significantly higher amongst female, among those who had visited their GP or FP and among those who had a parent with a college degree or higher. The proportion of emergency department visits and hospital admissions reported were 12.8% and 4.7% respectively. CONCLUSION This results highlights the need of educational interventions for parents and adolescents in order to increase the utilization of preventive health services.
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Affiliation(s)
- Flora Ascione
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
| | - Diana Cascone
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Via Luciano Armanni, 5, 80138 Naples, Italy
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Gontijo Guerra S, Vasiliadis HM. Gender Differences in Youth Suicide and Healthcare Service Use. CRISIS 2016; 37:290-298. [PMID: 27245811 DOI: 10.1027/0227-5910/a000387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need. AIMS To determine gender differences in healthcare service use 12 months prior to suicide. METHOD Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health). RESULTS Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p < .001) and had received a mental health-related diagnosis (46.7% vs. 33.1%, p < .001). However, no gender differences were observed in ED visits (59.5% vs. 54.5%, p = .150). CONCLUSION There is an important proportion of suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.
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Affiliation(s)
- Samantha Gontijo Guerra
- 1 Department of Community Health Sciences, Faculty of Medicine and Health Sciences of the University of Sherbrooke, Charles Le Moyne Hospital Research Center, Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- 1 Department of Community Health Sciences, Faculty of Medicine and Health Sciences of the University of Sherbrooke, Charles Le Moyne Hospital Research Center, Longueuil, QC, Canada
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Castro SS, Castaneda L, Silveira H. Identification of common content between the questionnaire of the Health Survey (ISA-SP) and the International Classification of Functionality, Disability, and Health. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 17:59-70. [PMID: 24896783 DOI: 10.1590/1415-790x201400010006eng] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/31/2012] [Indexed: 11/22/2022] Open
Abstract
The purpose of this paper was to identify the common contents between São Paulo's Health Survey Questionnaire (Physical Disability and Emotional Health Blocks) and the International Classification of Functionality, Disability, and Health. The first stage of the research consisted of the search for the modules of São Paulo's Health Survey, which addressed the issue of disability, and the passages about this theme were highlighted and inserted into a new file. In the second stage, the significant contents were extracted. In the last one, these contents were codified to the codes of the International Classification of Functionality, Disability, and Health by two independent researchers. For the descriptive statistical analysis, crude numbers, percentages, and simple frequencies were used. The degree of agreement between the two professionals was calculated using Kappa's coefficient and the confidence interval. The most common domains were those about functions and body structures and about activities and participation, in which the domain of environmental factors presented a lower frequency of approach.
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Affiliation(s)
- Shamyr Sulyvan Castro
- Departamento de Fisioterapia Aplicada, Instituto de Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Luciana Castaneda
- Instituto Brasileiro de Medicina de Reabilitação, Laureate Universities, Rio de Janeiro, RJ, Brasil
| | - Heitor Silveira
- Instituto de Psiquiatria Universitária Brasileira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Cooney N, Hiransuthikul N, Lertmaharit S. HIV in young people: characteristics and predictors for late diagnosis of HIV. AIDS Care 2015; 27:561-9. [PMID: 25671409 DOI: 10.1080/09540121.2014.986049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Late diagnosis of human immunodeficiency virus (HIV) infection remains a challenging issue, especially in young population, which accounts for approximately half of new HIV infections. This study aimed to assess factors associated with late diagnosis of HIV infection in young people. It employed a hospital-based case-control design, conducted during January 2012 through August 2013. A total of 193 patients aged 18-25 years old from 21 hospitals across Thailand were studied. Late diagnosis was defined as presentation when the CD4 cell count was less than 350 cells/µL within 12 months of the first HIV diagnosis, or AIDS-defining event is present within 12 months of the first HIV diagnosis. Factors associated with the late diagnosis of HIV were those who: did not live with their parent (OR 3.87; 95% CI 1.40-10.66), had no children (OR 3.25; 95% CI 1.27-8.31), had their first sexual intercourse at age older than 18 years (OR 4.25; 95% CI 1.27-14.22), had same-age or older partners (OR 3.36; 95% CI 1.39-8.08), were substance users (OR 3.65; 95% CI 1.22-10.88), believed they changed their behaviors after receiving HIV education (OR 2.48; 95% CI 1.02-5.99), and sought care at regional (OR 3.19; 95% 1.31-7.79) or general hospitals (OR 3.34; 95% 1.07-10.35). Strategies for early HIV detection in young people should be reconsidered; particularly the involvement of parents and targeting the right population.
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Affiliation(s)
- N Cooney
- a Department of Preventive and Social Medicine, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
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